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					THINK-TANK                                                                                                                                                                                  They can now charge as much as they
                                                                                                                                                                                        think they can squeeze out of patients.
                                                                                                                                                                                        Charges tend to vary, depending on the

 Medical care is
                                                                                                                                                                                        patients’ addresses, whether they have
                                                                                                                                                                                        medical insurance policies or are dressed
                                                                                                                                                                                        expensively or wear jewellery. Foreign
                                                                                                                                                                                        patients are more likely to be overcharged
                                                                                                                                                                                        because they have no time to shop
                                                                                                                                                                                        around. I know first-hand of an Indone-
                                                                                                                                                                                        sian patient who was charged $100,000

 not a commodity
                                                                                                                                                                                        for a simple laparoscopic removal of a
                                                                                                                                                                                        gall bladder, a procedure that usually
                                                                                                                                                                                        costs $10,000 in the private sector. There
                                                                                                                                                                                        have been enough cases of shameless
                                                                                                                                                                                        profiteering to earn some private hospi-
                                                                                                                                                                                        tals here a bad reputation.
                                                                                                                                                                                            Public-sector doctors cannot over-
                                                                                                                                                                                        charge because their fees are fixed by the

                                                                                                                                                                                        Ministry of Health. Many of us in the pub-
                                                                                                                                                                                        lic sector have had friends, both local and
               OST developed countries                                                                                                                                                  foreign, ask us for advice about which
               believe that the free market                                                                                                                                             doctors in the private sector they should
               is the best system for                                                                                                                                                   consult. They know that without medical
               allocating scarce commodi-                                                                                                                                               information, they are unable to tell which
               ties. The right price for                                                                                                                                                are the good doctors, professionally as
such commodities, they believe, is best                                                                                                                                                 well as ethically.
determined by allowing the forces of sup-                                                                                                                                                   The current situation, with some
ply and demand to operate freely.                                                                                                                                                       specialists in the private sector overcharg-
    But a free market can work efficiently                                                                                                                                              ing, is bad for Singapore. The Govern-
only if sellers and buyers have roughly                                                                                                                                                 ment hopes to promote medical tourism.
equal knowledge about the commodities                                                                                                                                                   But news of overcharging spreads very
changing hands. Such a condition does                                                                                                                                                   quickly abroad. Unless action is taken
not always exist. Medical care, especially,                                                                                                                                             soon, greed will kill the goose of medical
cannot be priced like any other commodi-                                                                                                                                                tourism before it has had a chance to lay
ty because the seller (the doctor) has                                                                                                                                                  any egg, let alone golden ones.
much more information than the buyer                                                                                                                                                        Overcharging is also bad for Singa-
(the patient).                                                                                                                                                                          pore’s medical fraternity. Young doctors
    The patient is therefore at the mercy                                                                                                                                               watch what their seniors do and will over-
of the doctor, not only in terms of what                                                                                                                                                charge too when they enter private prac-
he is charged but also in terms of what he                                                                                                                                              tice. As it is, there is already an erosion of
needs to “buy”. For example, procedures                                                                                                                                                 medical ethics here – not only because of
                                                                                                                                                                                        overcharging, but also because of super-
that may be unnecessary, such as blood
                                                                                                                                                                                        fluous referrals to other specialists who
tests and radiological examinations, may
                                                                                                                                                                                        are one’s personal friends, unnecessary
be ordered by a doctor, and the patient                                                                                                                                                 and expensive investigations and even
would be in no position to refuse.                                                                                                                                                      some unnecessary procedures that carry
    One could argue, of course, that                                                                                                                                                    risk of harm to patients.
patients can shop around to find doctors                                                                                                                                                    Medicine as a profession is a calling,
who would offer them the cheapest pack-                                                                                                                                                 and medical care cannot be treated as a
age. But this is impractical: Patients with                                                                                                                                             mere commodity. If the medical fraterni-
urgent medical problems do not have                                                                                                                                                     ty does not act soon to cajole or coerce
time to shop around. Patients from for-       fees for various medical procedures. It           In such cases, the SMA would request      consumers from being overcharged by           the black sheep among us to stop taking
eign countries would want to get their        was only a guideline, so doctors could de-     the relevant doctor to justify the extra     allowing free-market forces to determine      advantage of patients, Singapore’s reputa-
medical problems attended to quickly so       viate from the quoted fees if they wished.     charge, and if there was no reasonable       prices. And the GOF was designed precise-
                                                                                                                                                                                        tion will suffer and all its doctors will be
that they can return home. Moreover, pa-      However, if they did so, they were expect-     explanation, it would advise the doctor to   ly to protect patients from being over-
                                                                                                                                                                                        tarred by the same brush. If we delay
tients are usually informed of the medical    ed to inform patients in advance.              refund the difference. This advice was       charged by private medical specialists –
                                                                                                                                                                                        reforming the system, its faults will
                                                 This enabled patients to know what          also transmitted to the patient who com-     always a possibility given the asymmetry
procedures they require only after consul-                                                                                                                                              become more difficult to reverse.
                                              was the “premium” they were expected           plained. Most doctors who overcharged        of information between doctors and
tation with a doctor. They do not know                                                                                                                                                      Reviving the GOF would provide one
                                              to pay for the exceptionally superior treat-   without good reason followed the SMA’s       patients.
beforehand what they would require in                                                                                                                                                   solution to the problem of overcharging.
                                                                                                                                             To abandon the GOF on the grounds
order to shop around effectively. This,       ment their doctors were promising, and         advice and refunded the money. The                                                         It is not a perfect solution but, as with
                                                                                                                                          that it is anti-competitive is so illogical
together with the time constraint, makes      they could decide for themselves whether       guideline worked, functioning both as a      that I wonder whether anyone in the           many other problems in life, there is no
it impossible for most patients to make       they wished to pay that premium.               moral and practical rubric.                  Competition Commission of Singapore           perfect solution. We know that the GOF
an informed choice among doctors.                Sometimes, patients discovered they            In 2006, the SMA abandoned the GOF        understood that medical fees cannot be        will work – because it did.
    Prior to 2006, the Singapore Medical      were charged much more than what was           because it was encouraged to believe that    determined by free-market forces. The         The writer is Director of the National
Association (SMA) had a “Guidelines on        recommended in the GOF only after they         the guidelines might contravene the Com-     abandonment of the GOF has made               Neuroscience Institute. Think-Tank is a weekly
Fees” (GOF) for doctors in private prac-      received their bills. Some complained to       petition Act. Ironically, the purpose of     patients the easy prey of unscrupulous        column rotated among eight leading figures in
tice. The GOF recommended a range of          the SMA as a result.                           the Competition Act was to protect           private specialists.                          Singapore’s research and tertiary institutions.